<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">请选择企业:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-company_id" data-rule="required" data-source="company/index" class="form-control selectpage" name="row[company_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">服务站或者代理:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-service_agent_id"  data-source="service/agent/index" class="form-control selectpage" name="row[service_agent_id]" type="text" value="">
        </div>
    </div>
<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input id="c-name" class="form-control" name="row[name]" type="text" value="">-->
<!--        </div>-->
<!--    </div>-->
<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">产品分类:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input id="c-product_category_ids" data-rule="required" data-source="product/category/index" data-multiple="true" class="form-control selectpage" name="row[product_category_ids]" type="text" value="">-->
<!--        </div>-->
<!--    </div>-->
<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">环境分类:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input id="c-env_category_ids" data-rule="required" data-source="env/category/index" data-multiple="true" class="form-control selectpage" name="row[env_category_ids]" type="text" value="">-->
<!--        </div>-->
<!--    </div>  -->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">商品:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-goods_id" data-rule="required" data-source="product/goodsselect/indexs"  data-field="title"   data-multiple="true" class="form-control selectpage" name="row[goods_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">检测需求:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-content" data-rule="required" class="form-control" name="row[content]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-status" data-rule="required" data-source="order/orderStatus" data-field="status"   class="form-control selectpage" name="row[status]" type="text" value="0">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">订单价格:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-price" data-rule="required"  class="form-control" name="row[price]" type="number" value="0">
        </div>
    </div>
    <div class="form-group">
        <label for="c-voucher_img" class="control-label col-xs-12 col-sm-2">支付凭证:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-voucher_img" data-rule="" class="form-control" size="50" name="details[voucher_img]"
                       type="text"
                       value="">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-voucher_img" class="btn btn-danger faupload"
                                  data-input-id="c-voucher_img"
                                  data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp"
                                  data-multiple="false" data-preview-id="p-voucher_img"><i
                            class="fa fa-upload"></i> 上传</button></span>
                    <span><button type="button" id="fachoose-voucher_img" class="btn btn-primary fachoose"
                                  data-input-id="c-voucher_img" data-mimetype="image/*" data-multiple="false"><i
                            class="fa fa-list"></i> 选择</button></span>
                </div>
                <span class="msg-box n-right" for="c-voucher_img"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-voucher_img"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">联系人:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-link_name" data-rule="required"  class="form-control" name="row[link_name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">联系电话:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-link_phone" data-rule="required"  class="form-control" name="row[link_phone]" type="text" value="">
        </div>
    </div>

    <div style="width: 100%;margin:  0 auto">
        <div class="form-group">
            <label for="" class="control-label col-xs-12 col-sm-2">地址</label>
            <div class="col-xs-12 col-sm-8"><input type="text" class="form-control" name="row[address]" id="address"
                                                   placeholder="地址"></div>
        </div>
        <div class="form-group">
            <label for="" class="control-label col-xs-12 col-sm-2">经度</label>
            <div class="col-xs-12 col-sm-8"><input type="text" class="form-control" name="row[lng]" id="lng"
                                                   placeholder="经度"></div>

        </div>
        <div class="form-group">
            <label for="" class="control-label col-xs-12 col-sm-2">纬度</label>
            <div class="col-xs-12 col-sm-8">
                <input type="text" class="form-control" name="row[lat]" id="lat" placeholder="纬度">
            </div>

        </div>
        <!--    <div class="form-group">-->
        <!--        <label for=""></label>-->
        <!--        <input type="text" class="form-control" name="" id="zoom" placeholder="缩放">-->
        <!--    </div>-->
        <div class="form-group">
            <label class="control-label col-xs-12 col-sm-2"></label>
            <div class="col-xs-12 col-sm-8">
                <button type="button" class="btn btn-primary" data-toggle='addresspicker' data-input-id="address"
                        data-lng-id="lng"
                        data-lat-id="lat" data-zoom-id="zoom">点击选择
                </button>
            </div>
        </div>

    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">备注:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark"  class="form-control" name="row[remark]" type="text" value="">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
